It is hard to argue with their findings:

• Long backboards are commonly used to attempt to provide rigid spinal immobilization among emergency medical services (EMS) trauma patients.  However, the benefit of long backboards is largely unproven.
• The long backboard can induce pain, patient agitation, and respiratory compromise.  Further, the long backboard can decrease tissue perfusion at pressure points, leading to the development of pressure ulcers.
• Utilization of backboards for spinal immobilization during transport should be judicious, so that the potential benefits outweigh the risks.

I know that I have been torn in my own mind while strapping an octogenarian to a rigid long backboard when the only indication for such treatment was that she slipped on the floor of a rest home.  Neurologically she may appear completely intact with a normal level of consciousness (GCS of 15), no complaints of numbness, lacking any spinal deformation or distraction injury.  However, our protocols say she must be strapped to a rigid device without padding and subjected not only to the jolts of our handling, but every bump of a threshold as the stretcher is wheeled outside and then she continues to suffer the uneven pavement between the Emeritus Senior Living facility and the hospital.  If she wasn’t sore due to the fall, she will definitely feel it by the time she is seen by a physician.  I know I am protecting myself from any potential injury lawsuit, but am I really protecting my patient?

The Prehospital Emergency Care statement suggests criteria where use of a long backboard would not be indicated.  Part of that definition includes the following recommendation:

• Spinal precautions can be maintained by application of a rigid cervical collar and securing the patient firmly to the EMS stretcher…

While I can imagine the greater comfort for my patient and even see the potential for improved spinal protection, it remains just a thought until the concept is adopted by my Medical Director and written into our protocols before I can actually change my behavior.  While I applaud the new recommendations in this position statement, I feel powerless as I continue to apply a non “evidence-based” treatment to my patients.  The primary restraint to change is not medical evidence, however; it is a lack of confidence that the field EMS personnel can make proper judgement calls on when the treatment is indicated or not.  What I fail to understand is how it would be significantly different as we are already given specific latitude to make that call only it is constrained by a far more conservative set of criteria.  Here is hoping a change can happen soon.

And it doesn’t always have to be the setup of a deranged psychopath to present a danger, there are times I have simply gone to the wrong address.  And in my state, a homeowner is justified in using “deadly force” on anyone who “was in the process of unlawfully and forcefully entering a home.”  Hopefully by announcing myself and asking who called 9-1-1, I can argue the “unlawful” part if logical debates were possible in those late night situations.  Fortunately, I have never found myself in a situation where my life was truly in danger.  But I suspect other responders have felt that same casual assurance before things went sideways for them.  Arming medics is also not the answer.  My “concealed carry” training was very good, but it doesn’t begin to help me understand how to react in a hostage taking situation even assuming my hands weren’t already full of equipment when entering the room.

I read of states like Iowa and New Jersey that are having trouble recruiting volunteers and in some cases offering incentives for service.  I have always felt that EMS is a calling however.  We don’t just need more bodies in uniform, we need the right people to care enough about helping patients.  We also need to do a better job of protecting the professionals (including volunteers) who give of themselves already.  We must use the CLIR E.V.E.N.T. database to share experiences of how to make EMS safer and better for responders as well as patients.  Take the recent events that have happened and let them make you more aware, not more afraid.  Work with others to help them understand the real-world of “scene safety” and practice it in every call.  Let your “index of suspicion” always include your own safety, because we need you back doing this job again tomorrow!

Part 4: Provider Culture

Protocols and Standards of Care are documents that describe what should be done for patients, however these actions must be implemented by the people who work for a service.  Since the quality of care (and even patient satisfaction) is exclusively implemented by these individuals, often in extreme conditions, it seems counter-intuitive that the jobs they fill are regularly listed in surveys of The 10 Most Underpaid Jobs.  Part of the reason the pay remains so low for a position that is so widely recognized as being critical by the public is that it is still seen as a vocation taught at community colleges and even high schools rather than as a profession.  In some cases, EMS is even treated as a certification that simply becomes a gateway to another job.

The demands on Emergency Medical Technicians (EMTs) and Paramedics is strenuous both physically and mentally.  Some statistics I have heard suggest that one in four EMS workers will suffer a career ending back injury within the first 4 years of service while others may last only 5 years before the accumulated stress becomes almost intolerable.  Those who make it longer often become jaded and cynical due in part to monotony or exposure to patients who seem to routinely abuse the system.  It is important that the culture of a highly performing EMS service not view an employee seeking help in dealing with stress as being weak but rather look to support that comrade through their feelings.  There are resources readily available to help EMS personnel facing burnout Learn to Cope with Stress.  From a very practical perspective, it is typically cheaper to retain a senior employee, even one facing issues, than it is to train a new hire in the organizational way of thinking.

Another real fear that EMS agencies should understand is the problem of complacency.   Disengaged employees cost the US economy around $300B year.  And worse yet, for EMS agencies, this behavior means lawsuits, bad press, patient dissatisfaction, and employee retention problems.  A service culture than promotes performance encourages positive role mentors at all levels.  It is important to pay attention to the characteristics of new hires and to personally examine what type of personality you bring to your organization.  The chart to the right highlights some important character traits to look for in potential employees as well as yourself.

There are two ways to look at the problem of employee satisfaction: is your service hiring the right sorts of people and are you the type of person that the service you actually want to work for is actively hiring?  If you don’t know what the criteria of a good employee are, here are 8 Qualities To Look For When Hiring A Responder.  But again, the other consideration is whether your service is a place with whom professional minded individuals are interested in working.  Here are  6 Culture Building Principles for Your Response Team that promote professional performance and loyalty within the organization.

Leadership is key to authority in any group.  Unfortunately, the only form of authority that can be confirmed on anyone is just “command.”  The role of “leader” must be earned.  True leadership comes from developing respect, not demanding loyalty.  It is developed through an understanding of the job you request others to perform and an appreciation for the way the tasks of that job are carried out.  A high performing EMS promotes a “just culture” where positive behavior is rewarded at least as much as poor behavior is reprimanded.

Just as their is no single “correct” model for EMS delivery, there is no single pattern of employee relations.  Professionally minded employees must find the right service provider culture for them.  Similarly, agencies should demand high performance from those who wear their uniform in order to instill pride both ways.

Wednesday:  Improvisation is a primary characteristic of both EMS professionals as well as politicians.  Fortunately, both implemented plenty of it on Wednesday during a modified “EMS on the Hill Day” event sponsored by NAEMT in conjunction with the conference.  While not as many elected representatives were available as hoped due to a weather-related shut down, there was opportunity to explain the impacts of legislation such as PPACA (“ObamaCare”) and the Field EMS bill on our industry to those who knew where it was happening.  (An awareness shared by those attendees who participate in social media at conferences.)  This is an important annual day of advocacy open to all EMS professionals who register in advance and one that everyone should be involved in supporting.  As representatives were found to be available, they were visited by attendees on your behalf.

For those of us attending the impromptu hotel meeting, we heard several good speakers on topics passionate to them. Matt Zavadsky of “MedStar Mobile Healthcare” (formerly “MedStar EMS”) discussed his agencies view of changes to the industry saying “we are not Emergency Medical Services (any longer), we are Unscheduled Medical Services.” Others, like Chris Montero, spoke on our increasing role in public health and promoting community paramedics.  One easy example was assisting with ”mobile immunizations” for the community (or what was jokingly termed “drive-by shootings”).  Later in the evening JEMS announced the “EMS 10″ Award Recipients for 2012 at a special gala event recognizing those who drove the EMS profession forward.  It is definitely worth reading through the accomplishments of these individuals and agencies and commit to continue their work nationally.  LeFlore County EMS located in “super rural” Oklahoma, just as an example, improved their save rate from 6% to 40% and has not failed an intubation in 3 years.

Thursday:  By far the busiest day with endless concurrent sessions.  I tweeted as many of the pearls of wisdom that I heard live as fast as I could.  Whether you are attending a conference or not, the ability to share knowledge through social media at an event like this is incredibly valuable.  For those at home or on the job, it was their first opportunity to hear even pieces of great lectures and those in the same room get to hear what resonates with others immediately.  One of the key points I took away from this day of courses was that as an industry, we need to communicate that EMS response is more than a measure between receiving a call in the dispatch center and the wheels of an ambulance hitting the curb at the scene.  It is also important that we “take stock of our dysfunctions in order to embrace the change that means improvement for the benefit of our patients.”

Representatives from the “Gathering of Eagles” presented in a forum session where several “sacred cows” of pre-hospital care were lined up for the slaughter.  Such controversial ideas as: “IVs being the only method to administer drugs is becoming an antiquated idea”; “to save patients as well as money, focus on driving safety and alternate endpoints for treatment”; or ”where are the papers that support the benefits of the backboard?”   Cervical collars, it was argued to the delight of the crowd, properly strapped with patient on a stretcher can be safer than a “slip-n-slide” (i.e. “backboard” which can add to compression/decompression injuries during transport.)  I know many of us are watching intently for the paper coming soon on new ideas for spinal immobilization. In short, the best summary of the “Eagles” session was ”everything is changing.”

Another informative and challenging session was “What EMS has Learned from the Iraq and Afghanistan Battlefield” with Peter Taillac. Much of this presentation focused on the return of the tourniquet.  This device, according to Tallic, got a bad rap because there was historically no evacuation plan once applied, but more recent research shows that survival rates for patients are 96% if a proper tourniquet is applied before signs of shock are present while rates decrease rapidly to only 4% when it is used only as a “last ditch effort.”  The other challenge to traditional thinking was stated clearly in the thought that ”‘only a doctor can remove a tourniquet’ is “bullshit.”  Medics should apply tourniquets early, as indicated, but reassess the need for a tourniquet during transport and remove if possible.  One warning, however, is that if blood pressure increases after removal, the likelihood of “popping a clot” increases too.  However, he contends that the goal of an IV is to prevent shock by maintaining perfusion not returning normal blood pressure in the field.  Tallic also praised topical hemostatic agents when used properly but chastised the industry in general saying that typically “EMS sucks at pain control.”

The opening ceremonies on Thursday night had all of the requisite pomp and ceremony to make any fire-based EMS service feel comfortable.  But it was all pure EMS history as Dan Swayze of the Center for Emergency Medicine in Pittsburgh (CEM) led the audience through a dramatic trip of historic ”pre-hospital medicine firsts.”  I know I had personally wondered where some practices came from, but it was definitely thought-provoking when Dan asked, “so, you are the first person to ever attempt increasing blood flow with direct intravenous fluids, how do you do it?”  Following this presentation, the exhibit hall was officially opened and I got to attend the premier of the latest Code STEMI video in the inspiring FRN series taped this time at the world’s busiest EMS service.  Take a look and share it as part of the “Community Connected” initiative I mentioned in my last post.

Friday and Saturday: Continued more sessions and time in the exhibit hall as well as annual favorites like the JEMS Games and the Cook-Off Challenge.  Unfortunately, I had to leave before the closing ceremonies and last session, “Gaining and Keeping the Public’s Trust” by a popular and entertaining speaker, Gordon Graham.  I do look forward to next year though and hope to see you there.

Part 3: Community Connected

When the modern idea of EMS began decades ago, the driving force related to fast response. It was simply about getting someone with some medical training to the scene of a trauma quickly.  There was a wave of need and few other options at the time.  Times, however, have changed the basic equation.  As EMS continues to evolve we debate what our new role really needs to be.  Are we primarily “public safety” as we have been or are we better viewed as an integral part of the “medical profession”?  Your answer, unfortunately, may be predicated on the type of service in which you work.  This isn’t part of the problem, but it is an impediment to the progress that must be made.  If we were able to start all over again today by designing a new EMS system, would it resemble anything like what we have today?  Of course, we don’t have that luxury.   However, that sort of vision can help us steer a course through the inevitable transition that is already happening.  The status quo is no longer sustainable.  Between budget forces and expectations of service, our jobs will change.  We can try to affect that change through the hierarchy of command, we can make a difference at the individual level through personal commitment, or we can enlist the community for the direction and support of the change THEY want.

If we examine expectations of the communities we serve through the requests they make to us, we should recognize a general shift from trauma related to motor vehicle accidents toward more purely medical “sick calls” in the home or office.  A small proportion of these calls are the dramatic cardiac or stroke cases we train so diligently to address.  But to the ailing patient, the perception they have can be very different from ours.  But is that difference in perception only ignorance on the part of the public or a failure of ours to connect and inform them of what we can – and cannot – do.

I am encouraged by the innovation and early acceptance of “community paramedic” programs.  These models allow for professional development of practitioners in the home setting while also meeting the needs of the community and still saving overall healthcare dollars.  I am concerned over how these programs are funded, however.  Without appropriate economic incentives for reimbursement, the developing models cannot be sustained even though they reduce overall costs since the investment shifts the financial burden to non-traditional definitive medical providers.  A key to success, therefore, will be public demand for services and an appreciation for the capabilities offered.  But this shift of recognition will only happen if the public becomes knowledgeable and engaged in the development process.

Even if you do not subscribe to the idea of such significant change to subsidized out of hospital care, there are other potentials for community involvement that will pragmatically improve the effectiveness of emergency care such as empowering bystanders to act.  Even though a recent UK Survey Shows 9 out of 10 Would Not Use an AED if faced with an emergency cardiac arrest, it is the general public that is available to respond much faster in most circumstances than even First Responders due to their sheer numbers and proximity to witness events.  In areas where the public is better trained for emergency care, patients are more likely to survive because  Bystander Intervention Can Mean the Difference Between Life and Death.  If we are to meet the challenge we have accepted as emergency care providers, we must realize that enlisting the help of the public through awareness and training is imperative to our mission and that a failure to inform the public of at least basic knowledge and skills is negligence on our part just as a Retirement Home Nurse Refuses to Perform CPR on Dying Woman.

Part 2: Effective Care

While being effective in our care of patients should be an automatic criteria, I believe there is still plenty to say on the topic.  The American Heart Association re-evaluates its approach routinely to cardiac care every two years.  How often do we truly examine our practices in the “out-of-hospital” emergency care profession where we know that patient demand and provider skills are constantly changing?  In the past several months, I have seen articles challenging standard practices toward intubation and c-spine immobilization – basic tenets of our practice – but how many agencies have made any significant investigation toward change in these protocols?  For its part, The Army Awards Follow-On Contract for Autonomous Airway Management to Energid Technologies to create robots that can perform endotracheal intubation.  Before we answer the question of whether robots or people are better at ETI, shouldn’t we answer the question regarding efficacy of the practice for the patient or refine the scope of practice regarding it?  Similarly, other detailed questions are being raised like Is the 6-12-12 adenosine approach always correct?  Is the closest facility really the best facility and who is allowed to make the call of an appropriate destination when EMS strategy change gets heart patients faster care?  Is public perception or even financial reimbursement a more important driver?  Please don’t think I am just being cynical, I believe that the return of the tourniquet is a good example of evidence-based practice in practice.  While we don’t want to see protocols change like fashions, we need to avoid viewing them as sacred writings as well.

This next point may need to a separate topic altogether, but as an example of considering all parties involved, lets look critically at a new protocol that has been introduced at many agencies including the service where I work.  For cardiac patients requiring CPR, it is now to be done on-scene for at least twenty minutes or until ROSC.  If resuscitation attempts are ended, the body is left.  Just last night, I departed a scene of the cardiac arrest of a mother leaving her cyanotic body in the home with her husband and 5 yo daughter.    I admit that I was relieved not to have to transport, but I was equally mortified to leave the grieving family in that way.  Perhaps there isn’t always a good answer, but do we communicate the reasoning behind the decision or just the alteration of the  protocol itself?

In my mind, EMS personnel are consummate professionals.  But how does the system view these providers of emergency care?  I was involved in a serious debate recently over whether EMTs are qualified to place the pads for 12-lead ECGs to be transmitted for interpretation at a receiving facility.  I was surprised to find that there was any serious question.  Are we more concerned over maintaining a strict division of labor skills for the benefit of the provider even over the needs of a patient?  Think of the combined experience out there.  There are many innovative EMS personnel, who out of necessity (or extreme practice) create better “mouse traps” such as the REEL Splint or WauKboard for example.  Paramedics, EMTs, and even Medical First Responders must not be viewed simply as automatons that can only repeat protocol standards, but capable of some judgement within the limitations of their qualifications and skill level.  But whether it is the fault of EMS personnel who attempt to skate by with minimal effort or the cautious medical director who sees the wide disparity in knowledge (or more accurately “wisdom”) in the staff, many good professionals are being short changed.  It is our responsibility, whether an EMR or MD, to teach and even police, “our own”.  We must hold each other up to the standards we want to examined by and to guide our profession.

You are required to bring about the next generation of EMS, the so-called EMS 2.0 revolution by your actions.  EMS World recently published a article to help you move in that direction in their Quality Corner: How to Make Better EMS Providers.  Don’t view “professional” as a title, but as a calling to service in always providing “effective care.”

Part 1: Response Time

This past February, Elsevier published an excellent newsletter (EMS Insider, Volume 39, Number 2) focused on EMS response times and included articles such as “The Great Ambulance Response Time Debate Continues” in which the author, Teresa McCallion, laid out many of the facts.  For instance, the article recites the “MedStar example” from Super Bowl XLV suggesting that “very few EMS calls” in that prospective two week study actually “required an immediate response.”  It is important to note that this statement did not go so far as to say that response time is meaningless in all cases – just that it is far less limited in most.  Then as counterpoint to dismissing response times altogether, the public conflict at EMSA in Oklahoma City was brought up where at least one politician complained of the number of excluded calls required in order to reach a 90% response time compliance rate.  This is only a single instance, but we all understand that it is certainly indicative of how the public measures the value we provide.  In the conclusion, Matt Zavadsky, MedStar EMS Associate Director for Operations, offered several good recommendations to improve patient outcomes and public understanding of the EMS system.  While I agree with nearly everything he said, I would really only argue with his statement that began, “There is no such thing as an inappropriate request for 9-1-1,” (which is a whole other topic) but then he added “there is such a thing as an inappropriate response to that request.”  I can only assume he was referring to the fact that accidents sometimes happen en route to calls.  While these incidents point out failures in judgement somewhere, it is not the “response” itself that is at fault.

Zavadsky also authored another article in that newsletter entitled “Response Time Realities: The Scientific Evidence.”  Interestingly, several of the studies he cites actually help to make the case for effectively reducing response times under 4 or 5 minutes in certain cases rather than eliminating the standards in general.  Furthermore, the quotes he uses from the 2008 “Gathering of Eagles” consortium position paper entitled “Prehospital Emergency Care” do not discount the time of a response, but instead point out the unsupportability of “over-emphasis on response-time interval metrics” compared to the “unintended, but harmful, consequences (e.g. emergency vehicle crashes) and an undeserved confidence in quality and performance.”  While I also cannot justify the 7:59 standard used in many urban areas, I also cannot condone apathy toward responding timely.  Maybe I am overly sensitive to the literal meaning of “response time doesn’t matter” when justified with the statement that the “golden hour” is just a myth.  For most of us, at least 10-20% of calls include a cardiac, respiratory, stroke or other event where time really is critical and we must be at the top of our game to prevent a death or minimize as much loss in quality of life as possible.

My concern in these arguments is an unstated bias that “response” means only the arrival of an ALS-experienced paramedic traveling with red lights and sirens from a fixed fire station.  Technically, “response” must be understood as simply the time between a call for emergency assistance and the initiation of appropriate necessary treatment.  For many calls, that care could be BLS-led in most circumstances assuming that the calls are appropriately triaged at dispatch.  Emergency Medical Dispatch itself even provides some level of immediate guidance in care with a response time of zero.  Additionally, the greater availability of defibrillators as well as more common knowledge of compression-only CPR means that initial emergency life-saving care can be initiated well before any ambulance arrives.  The existence of advanced telemedicine devices (such as the LifeBot-5) are also changing the rules by providing advanced medical consultation even more quickly in remote rural areas typically with far longer average ALS arrival times.

My point is not necessarily trying to get medical responsders moving faster, but to redefine response time not just as the metric for the ambulance arrival to justify budgets but as a factor that affects patient outcome.  There are many ways to achieve this goal and it begins as education within the system as well as with the public because technology is changing the dynamics.  Zavadsky’s points are valid.  Making defibrillators more available and teaching the public how to respond when a medical event is witnessed is critical.  Also while adding ambulances and staff to more locations would be another way to address reducing response time, it is not financially practical.  An effective alternative to achieve that same goal would be to position the responders closer to the call thereby minimizing distance and the associated need for risky driving.  Modern “dynamic system status management” practice has proven that response time can be shortened to most calls (at least 80-85%) without the need for excessive driving risk that places crews or the public in danger.  Improving performance means responding appropriately in less time – not necessarily just responding “faster.”  Technology can be evaluated as being “outcome-based” just the same as patient treatments.

Watch for future posts which will highlight other components of performance-based EMS beyond just measuring and improving response time.

11th Annual Paramedic Competition

Think you’re the best at what you do? Do you have the skills to beat out all others? Do you like to show off those skills? Come on up to Oshawa, Ontario Canada and prove it!

Teams compete in one of three divisions:  Advanced Care Paramedic, Primary Care Paramedic and Primary Care Student.  For competitors unfamiliar with those terms, ACP may likened to EMT-P while PCP may be considered to be EMT/EMT-I/etc.  The scope of practice for each paramedic level may be found by reading the National Occupational Competency Profile (updated 2012) created by the Paramedic Association of Canada.  If you are unsure of which division you should be competing in, please contact us to discuss your situation.

A “Team” is considered to be 2 Competitors and 2 Judges.  The judges will be separated from their teams and will not judge their own team at any time.  In the spirit of the competition, judges are expected to be fair and non-biased in their judging of other teams.  The competition relies on honesty on the part of both competitors and judges to ensure a fair outcome and a great experience for everyone.  Judges are expected to be certified at the same level as the competitors from their team.  Should a team not be able to provide two judges, we ask that you let us know as soon as possible so we can find replacement judges.  In the event that a team is unable to provide two judges, the lunch and banquet tickets assigned to the missing judges will be given to the replacement judges supplied by the committee.

The competition is a one day event that consists of practical scenarios using human actors as well as high-fidelity patient simulators along with academic tests and challenges.  This format has proved popular in the past and will be followed again for 2013

Businesses in the private sector have struggled for many years over the risk and rewards of giving employees increased access to sensitive corporate information from mobile devices.  Once the technology was finally embraced, the initial result was huge expenditures for company-owned devices that quickly became outdated.  As a result, many organizations have now embraced a BYOD (“Bring Your Own Device”) policy to leverage the employee’s willingness and need to provide current mobile technology for use outside of the office.  While it certainly increases the workload for corporate IT professionals to support and secure these devices, it has been determined that the improved productivity, increased job satisfaction, and in some cases even lowered equipment cost outweigh the investment.  The risk of exposure is still there, but when employees are properly treated as professionals they become empowered allies instead of floating liabilities.  In some ways the case is much easier for EMS.

In the EMS setting, there are countless objects, many provided inside an ambulance, that can harm a patient if they are misused or mistreated.  However, when they are used properly many of these same tools can mean an improved outcome for the patient or even the organization.  What makes the application different in either case is an implicit trust in the knowledge of the professional in applying it properly.  Recently, I have posted links on some uses of smartphones in EMS including Using an iPhone to detect ear infections.  Just today another post from my paramedic friend Greg Friese shared his slide set on Integrating Smartphones and Tablet Devices into EMS Education  from EMS World Expo.  Another paramedic friend named Chris Matthews maintains a blog site called The Unwired Medic specifically to share useful applications of mobile technology.  Whole businesses have sprung up to provide mobile applications for continuing education during downtime in the station or at a post as well as references to be used during a call.  Check out the Smartphones offer valuable, versatile tool article for many more uses.

The problem isn’t allowing another new device in the EMS setting, it is in establishing the mission, boundaries, and implications of improper use of whatever that new tool might be.  There are all sorts of potential problems with tools, but banning a potentially useful tool because of an employee trust issue is just a sign of deeper problems within the organization.

This type of re-categorization even extended into a restructuring of the organization around functional “centers of excellence” that would be geographically recognized.  San Diego, for instance, will become the center including GIS integration and Castle Hayne will host law enforcement functions.  Darrin Reilly, the new COO, explained the need to reorganize the company allowing them to take advantage of future trends given that fact that “IT evolution will be greater in the next 12-60 months than ever before.”

The apparent effect of this reorganization was already evident in the product demonstrations that began with a significant “rethinking” of the integration of CAD and E9-1-1.  An illustration that showed how CAD could work differently  - and even be implemented incrementally – contained significant integration with Google technology.  Integrating search powered by Google into the call-taking screen significantly enhances search as well as map display tools and ultimately dispatcher knowledge.

Integrating the phone system with the CAD enables new features such as automatic call-back dialing by clicking on the phone number displayed on the dispatcher’s screen.  Mapping of the incoming calls provides a visual “spatial awareness” that can provide advanced prioritization as a step toward Next Generation 911.  In the case where several incoming calls are clustered around a documented incident while others appear at a great distance, it can be assumed that certain calls may be redundant reports while others could be regarding new incidents.  The demonstration also showed the possibility of integrating live report calls directly into the TriTech Mobile application for immediate access by first responders.

There was more talk about the benefits of spatial technology integration yesterday with users asking for updates to the TriTech applications in order to support current ArcGIS 10 technology from Esri, but more focus seemed to be on Google-based mapping from the TriTech presenters rather further leveraging GIS technology beyond simple geographic display.

Then this morning Brian Fontes from NENA discussed the future of NG911 answering the questions “What is it and where are we going?”  Following that presentation were several other break-out sessions, many of which focused on law enforcement applications which appeared to me to be somewhat disproportionally represented given the audience.

Now off to TriFest in Old Town San Diego tonight…